Topical Issue Debate

Cross-Border Projects

I thank the Ceann Comhairle for the opportunity to raise this Topical Issue matter. As someone from the Clones electoral area, I am delighted to be in a position to discuss the Ulster Canal and the importance of this project to the Border region, in particular the section from Lough Erne to Clones, the first stage of the restoration project. There has been significant progress in recent weeks, with planning permission granted for the project north and south of the Border. I was pleased by last week's announcement by the Northern Ireland Minister of the Environment, Mr. Alex Attwood, MLA, that the planning application to restore the canal from Quivvy Lough to Gortnacarrow and on to Clones had been approved. This followed last month's approval for the southern part of the project. The Minister for Arts, Heritage and the Gaeltacht, Deputy Deenihan, stated that the approval of planning permission would be a significant milestone for the canal project. It is important we build on the progress.

The Ulster Canal is an important flagship cross-Border project that will bring many benefits in terms of tourism. We have seen this at first hand with the arrival of the canal to Ballyconnell and Belturbet, contributing significantly to the vibrancy of both towns. The town of Clones and the surrounding area were impacted upon by the Troubles. The building of the canal has given hope to many people in difficult times and its arrival is awaited with great excitement. Indeed, the project can be seen as a beacon of light for the people of Clones at the end of a dark tunnel.

The restoration of the Ulster Canal is a tangible North-South project that is testament to the commitment to peace and reconciliation in an area that was savaged by the Troubles in Northern Ireland. In this regard, I was delighted this week to hear the Tánaiste confirm during his visit to Stormont Castle that the Government was focusing on achieving a €150 million PEACE IV package for Northern Ireland and the Border counties during our Presidency of the EU. If such a funding package is secured, serious consideration should be given to ring-fencing some of it for the Ulster Canal project. I would welcome the Minister's opinion in this regard.

It is important that authorities North and South continue to work together to ensure the project's progress. I raised the issue at the inaugural meeting of the North-South Inter-Parliamentary Association. From those discussions, it is clear that the project has widespread support.

In light of the fact that planning has been approved, I encourage the Minister to ensure the project is raised by the Taoiseach and the Tánaiste with the First and Deputy First Ministers and put full square on the agenda for the next meeting of the North-South Ministerial Council.

The project is constantly on the local political agenda. My colleagues and councillors for the Clones electoral area, the mayor of Monaghan, Councillor Hughie McElvaney, and Councillor Ciara McPhillips, are present in Leinster House today. This is a project that is very close to their hearts and one on which they continue to work hard at local level.

The Ulster Canal project has cross-party support. Clones Regeneration Partnership, Clones Town Council and Monaghan County Council have done Trojan work together with Waterways Ireland to promote and progress the development of the canal project. Only today, I received an invitation to a conference on the Ulster Canal project which is to be held in the Creighton Hotel in Clones later this month.

I thank the Minister, Deputy Deenihan, for taking the time to visit Canal Stores in Clones some time ago where he confirmed his and the Government's continued commitment to the project. The challenge for us now is to build on significant recent progress. I look forward to hearing from the Minister in that regard.

I thank Deputy Humphreys for raising the matter and for her continuing and strong interest in advancing the project. Her colleague, Deputy Smith, has a similar interest.

The Ulster Canal is a total of 93 km long and extends from Upper Lough Erne to Lough Neagh. It runs through counties Armagh, Monaghan and Fermanagh. It was originally opened in 1841 to link the northern navigation systems to the western and southern systems via Lough Erne and the Ballinamore and Ballyconnell Canal. Due to operational and financial difficulties the canal struggled to be viable and was finally abandoned in 1931.

As canal re-opening progressed in the 1980s and 1990s, and following the success of the re-opening of the Shannon-Erne canal, a number of studies were carried out into the re-opening of the Ulster Canal or parts thereof. The studies concluded that the restoration of the Ulster Canal from Upper Lough Erne to Clones would be likely to have direct economic benefits and also encourage economic regeneration in the area by providing construction jobs through restoration and maintenance, increasing property prices, encouraging investment in the local area, increasing private consumption and creating long-term employment through increased tourism, construction, hospitality and the multiplier effects of increased spending.

It is anticipated that the re-opening of the Ulster Canal from Clones to Upper Lough Erne will also provide significant direct and indirect benefits in the areas of tourism and heritage. The canal is an invaluable heritage and cultural resource as it formed an intrinsic part of the development of the localities through which it passed. Its strategic value lies in its potential contribution to rural development in a disadvantaged area on the Border and in its key link within the existing inland waterway network across the island.

The outcome of these studies was that in July 2007, the North-South Ministerial Council, NSMC, agreed to proceed with the restoration of the section of the Ulster Canal between Clones and Upper Lough Erne, a distance of approximately 13 km. The Government at that time agreed to cover the full capital costs of the project, which were estimated to be of the order of €35 million. It was also agreed that Waterways Ireland would be responsible for the restoration of this section of the canal and following restoration for its management, maintenance and development. The annual maintenance costs, which are of the order of €300,000, are to be met by the Northern Ireland Executive and the Government.

Canal restoration projects have previously been shown to act as a catalyst for significant regeneration of rural communities, including tourism growth. As the waterways often run through less developed areas, their potential for acting as regeneration catalysts in this manner is considerable. The Ulster Canal project is a long-term investment in the economic regeneration of the surrounding rural communities in Cavan, Fermanagh and Monaghan that will reap long-term dividends. Evidence of the impact that projects such as this have on the ground can be seen from the very positive effects gained from the restoration of the Shannon Erne Waterway in the 1990s at a cost of IR£30 million.

Planning applications were lodged by Waterways Ireland with Monaghan County Council, Clones Town Council and Cavan County Council on 25 October 2011 and with the Department of the Environment, DOE, planning service in Northern Ireland on 28 October 2011. Cavan County Council granted planning permission on 14 December 2011. Clones Town Council and Monaghan County Council granted planning approval on 4 April and 8 April 2013, respectively. They are now in the four-week waiting period allowed for the possibility of an appeal to An Bord Pleanála. If no appeal is made, Clones Town Council and Monaghan County Council will issue grant of permission in early May. Planning permission has also been given by the Department of the Environment planning service Northern Ireland and announced by the Environment Minister, Mr. Attwood, in a press release of 25 April 2013.

I am afraid we are short of time. The Minister should be aware of that.

The planning applications for this project are now likely to be determined in May 2013. The compulsory purchase order, CPO, land maps are well progressed. It is estimated that the CPO process will take approximately 12 months and, depending on the funding in place, the CPO process may proceed incrementally. A decision on the construction of the project and on whether to have a single large contract or a number of smaller contracts will also have to be made. As the project is above the EU procurement threshold the tender process will be required to comply with the EU procurement process and will take approximately six months to complete. Taking that into consideration the earliest the contract could be awarded would be late 2014 with a contract period of 24 months giving a completion date of spring 2017. If the project is to proceed in a more piecemeal fashion the completion date could be some years later, depending on the number and timing of individual contracts. Funding for the project very much depends on the availability of funding from the Exchequer. Deputy Humphreys referred to the possibility of funding from a European source. The Taoiseach referred to a similar possibility.

I established an inter-agency group comprising county managers from Monaghan and Cavan, the director of leisure, development and arts from Fermanagh, representatives from the Northern Ireland Tourist Board, Fáilte Ireland, the Strategic Investment Board, Waterways Ireland and senior officials from the Department of Culture, Arts and Leisure, Northern Ireland and the Department of Arts, Heritage and the Gaeltacht. The inaugural meeting was held on 20 September 2012 and the next meeting will take place shortly. Its challenge is to find alternative sources of funding. I again thank the Deputy for raising the matter. With the planning permission process completed, the next stage is to acquire the land and we will proceed with that immediately.

I thank the Minister for his reply and for reaffirming the Government's commitment to the project. As I stated previously the project is a beacon of hope for Clones and the Border area and it is important that people are aware that the Government is committed to the project. I welcome the establishment by the Minister of the inter-agency group on the Ulster Canal. It has been charged with examining possible funding options for the project. In particular I would like it to explore the possibility of getting funding for the Ulster Canal from the potential €150 million PEACE IV funding that might come on-stream. The canal is an iconic, achievable project that is worthy of support. I assure the Minister that I will continue to work with him to the best of my ability to ensure the project comes to fruition, as I know all of the elected members and various groups in Clones will do also.

Potential funding from the €150 million PEACE IV programme is very important. If we could source funding from it that would give a greater possibility of the project progressing in the near future. I hope that having completed the CPOs we can make a start on the project in 2015 or 2016. As Deputy Humphreys indicated, it is an iconic project and it would give a major boost to that part of the country which has suffered considerably from rural depopulation. The farming community is under a lot of pressure as well.

Certainly, this project would be seen to be a major asset to the local community and local economy.

Foreign Conflicts

The tragedy unfolding before our eyes in Syria has claimed over 70,000 lives over the past two years, although I understand that is a conservative estimate of the terrible loss of life. The country has been consumed by a civil war that has caused a major humanitarian crisis in the region. The war has also served as a proxy battle between various states and factions in the Middle East. The announcement today by Hizbollah confirming its role in the conflict underlines the broad nature of this conflagration. More disturbing is the evidence that points to the use of chemical weapons in the country. President Obama has stated that chemical weapons have been used but that no chain of custody has been established. The United States of America has committed to reviewing its approach if it is clear that chemical weapons have been deployed and the hostile parties involved are identified. The most likely option is the selective arming of rebel groups in the war against the Assad regime if it is proven to have deployed chemical weapons.

Observers fear that as the war intensifies, the Assad regime will fall back on using chemical weapons as it runs out of other options. Alternatively, disparate rebel groups will acquire the weaponry which is dispersed across the country and use it as part of their arsenal. The presence of chemical weapons in a country tearing itself apart is a ticking time bomb. The humanitarian crisis will be on an even more unprecedented scale. The Syrian National Coalition, the umbrella opposition group that has been recognised by the West, has called on the UN Security Council to allow its inspectors in Cyprus to enter Syria to search for chemical weapons. In a statement, the opposition said: "We have confirmed reports from a number of countries in the world that the Syrian regime used chemical weapons on a limited scale, but it is seriously preparing for repeat use on a large scale, and the world must act before a major disaster occurs, not afterwards.”

The escalation of the threat begs the question as to what actions the EU will take in dealing with this crisis. Humanitarian assistance is one aspect but the prevention of the outbreak of chemical warfare must be of paramount importance. What actions will the Government support if there has been proven use of chemical weapons in Syria? What unity of purpose is there in the European Union to work alongside other international groups, such as other major powers and the United Nations, to give this major crisis the urgency and attention it deserves and to try to resolve this conflict, which is an unimaginable humanitarian disaster unfolding before us every hour of every day. Sadly, the work of the United Nations to date has been most disappointing.

I thank Deputy Smith for raising this important issue.

The European Union has repeatedly called on the Syrian authorities never to use its chemical weapons and to store them securely, pending destruction under independent verification. Ireland has made the same calls. Recent information which suggests that chemical weapons may have been used in Syria is of the utmost concern to us all. Any use of chemical weapons would have an appalling humanitarian impact, is clearly contrary to international legal norms and must be utterly condemned.

Information that chemical weapons may have been used in Syria first came to light last December. Additional allegations were made in March. On 20 March, the Syrian authorities formally requested the UN Secretary General to undertake an investigation into the allegations that chemical weapons were used in Khan AI-Assal, near Aleppo, on 19 March. Opposition forces denied that they had conducted these attacks and also alleged that the Syrian authorities had used chemical weapons in additional attacks in the suburbs of Damascus on the same day.

UN Secretary General Ban Ki-moon has agreed to undertake the investigation, with the support of the World Health Organization and the Organisation for the Prohibition of Chemical Weapons. In agreeing to undertake the investigation, the Secretary General stated that it must have unfettered access. He has also said that all serious claims that chemical weapons have been used should be examined without delay, without conditions and without exception.

The EU has written to the Secretary General to insist on a comprehensive investigation. The investigation team, led by Dr. Ake Sellstrom, has been established and is ready to travel to Syria at short notice. It is a matter of deep regret that the Syrian authorities have not yet agreed to the UN investigation team being given full and unfettered access. At the recent review conference of the chemical weapons convention, which took place only last month, the EU again expressed its grave concern at the allegations and again called on the Syrian authorities to permit the investigation to begin without delay. The 188 states which are party to the convention agreed that "the use of chemical weapons by anyone under any circumstances would be reprehensible and completely contrary to the legal norms and standards of the international community". While Syria is one of only eight states which is not party to the chemical weapons convention, it must not ignore this clear statement of principle made by the global community.

We have seen in recent days increasing indications that there is evidence to support the claims that chemical weapons, specifically the nerve agent sarin, have been used in Syria. These indications make it all the more urgent that the UN Secretary General be allowed to undertake his investigation without delay. The EU fully supports the UN Secretary General's efforts and stands ready to offer whatever support it can to him. Future steps which the EU may take must be on the basis of evidence.

I also wish to note that the EU is collectively the largest donor of humanitarian assistance to support the people of Syria, having committed over €600 million to date. This includes the €8.15 million that Ireland has contributed nationally, mainly through UN agencies and the International Committee of the Red Cross, ICRC.

Deputy Smith will be aware that last August I visited the Za'atri refugee camp, which was the first major camp established in Jordan to deal with the refugees and displaced persons from Syria. At that time I met the representatives of United Nations agencies, including UNICEF as well as the International Federation of Red Cross and Red Crescent Societies, and discussed the issue of refugee status and the difficulties that they were experiencing as a result of the terrible conflict that is continuing in Syria.

I thank the Minister of State for his reply and welcome his ongoing efforts and those of the Tánaiste to keep this issue on the agenda at EU level. Indeed, it is not long since myself and the Acting Chairman, Deputy Ann Phelan, raised this matter in a previous topical issues debate. It is an extremely difficult situation.

Last Wednesday, a former Member of this House, Barry Andrews, now CEO of Goal, addressed the Oireachtas Joint Committee on Foreign Affairs and Trade. He pointed out that after little more than two years of conflict, the most conservative estimates are that 70,000 people have been killed, 6.8 million people are in need of aid, 4.25 million people are internally displaced and 1.3 million are seeking refuge in neighbouring countries. It is estimated that half of the 6.8 million people in need of aid are children. He went on to say that it beggars belief that the world has allowed this tragedy to unfold and is still doing so little to halt it. He referred to a report in the New York Times last month indicating that less than 20% of the money promised by governments to the relief effort in Syria has thus far been delivered, which is nothing short of disgraceful. In that context, I appreciate what the Minister of State has done on behalf of the Irish taxpayer.

In conclusion, along with other members of the aforementioned committee, I received a briefing from Oxfam on this issue. The introduction states: "It will not be over until the great powers of the region and of the world unite to press all sides for peace. The world’s failure to do so over two bloody years is now shockingly compounded by the failure to provide sufficient funding soon enough for the humanitarian response."

The statement from Oxfam continues:

But by and large the world has sat back and watched Syria’s conflict and humanitarian crisis escalate out of all proportion to what could have been expected two years ago. Now is the time to escalate the humanitarian response.

I appeal to the Minister of State, along with the Tánaiste and every other Government representative with the opportunity, to ensure this is top of the agenda in discussions in all international relations. It is not widely enough known that this is the humanitarian crisis of our generation. We should do anything we can to urge action by international powers such as the United Nations. Regrettably, many of these major powers have stood back and not played the part they need to. I urge the Minister of State, his colleague, the Tánaiste, and other Government Members to keep this high on the agenda in all fora where they have a chance to contribute.

I know the Acting Chairman has an interest in the issue and she has raised it before. I take on board everything said by the Deputy about this significant tragedy. He mentioned a figure of 70,000 and the number has certainly risen, with probably 100,000 killed in the conflict at this point. The number of displaced persons is enormous, at 6.8 million, and surrounding countries have huge refugee camps. The UN Security Council is unable to formulate an agreed resolution because of different interests, which is an unsatisfactory response to the tragedy from the perspective of the global community.

There are allegations of chemical weapons being used by both sides, with an allegation that opposition groupings have used them in Aleppo and that the Syrian Government has used chemical weapons in Damascus. We do not have the hard evidence that would allow the United Nations or European Union to make a final decision. Undoubtedly, the use of chemical weapons crosses a line already mentioned by the international community and it could well be the game changer with regard to involvement. At this time there is no hard evidence and until the investigation team established by the UN Secretary General, Mr. Ban Ki-moon, is allowed access to verify the use or otherwise of such weapons, we will not be in a position to make a firm decision on what action can be taken.

I assure the Deputy that at every opportunity we will focus on the issue as much as possible. I may very well be returning to that theatre before too long and I know the Tánaiste has raised it at every opportunity in the European Union. We raise it on a regular basis wherever there is the likelihood of an impact being made in getting a solution. I thank the Deputy for tabling the issue and we will keep it under close examination.

Ambulance Service Provision

I am glad to have the opportunity to raise the proposed interim move of the Navan, Cork and Kerry ambulance control centres into one unit to be housed at the facility at Townsend Street in Dublin. The plans to create two new state-of-the-art control centres in Tallaght and Ballyshannon to manage all national emergency calls is very laudable and it is in accordance with international best practice. As the Minister of State knows, change is difficult and must be handled very carefully, especially when concerned with such a critical service as this. I doubt if anybody in the Chamber can point to such a critical service from a life-saving perspective as the ambulance service. The ability and capacity of the ambulance service to respond to emergencies should never even be tinkered with at the edges until we can all be confident that what comes after represents an enhancement.

Centralising the system in Tallaght and Ballyshannon, supported by the best personnel, technology and systems available, is a good move. However, it is bizarre in the extreme and, frankly, suspicious that the national ambulance service has unilaterally decided to centralise ambulance control from Navan, for example, and the other centres to a facility in Dublin 2 that will be shared with the Dublin fire brigade service for the moment. This begs the question of why two changes should be implemented over a short period when we only need one. This leads to the final resolution of the issue, which is the development of the facilities at Tallaght and Ballyshannon.

Surely this adds to the cost of change and risk of errors and accidents, as not all the existing control centres operate to the exact same procedures, which is a critical point. They do not have the same systems or formats. Additionally, there are practical concerns held by workers in the ambulance service that the control centre at Townsend Street is not physically capable of facilitating the extra staff and equipment required. This leads me to suspect that the proposed move to a new five-storey state-of-the-art facility in Tallaght may not go ahead at all.

It is important that the Minister of State should use the opportunity today to clarify the matter. When will this move ultimately take place, as there are suspicions that as a result of this interim measure, the ultimate move may not happen, at least in the timeframe laid out? In the meantime, I have yet to hear health and safety concerns around this proposed move being adequately addressed. I have yet to hear a solid rationale or any real justification for the interim measure or be convinced that this move will not potentially adversely impact the ambulance service and its ability to respond in a timely and efficient manner.

If no arguments exist, the ambulance service should ensure that the existing centres in Navan, which covers my area of Louth, and Cork and Kerry should be permitted to continue to operate ahead of the moving of the control aspect to the new national centres in Tallaght and Ballyshannon.

I thank Deputy Nash for raising the issue. A significant reform programme has been under way in recent years to totally reconfigure the way the HSE manages and delivers pre-hospital care services to ensure a clinically driven, nationally co-ordinated system, supported by improved technology. The National Ambulance Service, NAS, is not a static service and it deploys its emergency resources in a dynamic manner and works on an area and national, rather than a local, basis. The NAS has been addressing response times through a number of measures, including the performance improvement action plan, the development of the intermediate care service, the trial emergency aeromedical service, and the national ambulance service control centre reconfiguration project.

The national control centre will consist of one national control system on two sites - Tallaght and Ballyshannon - and it is intended to improve dispatch and response times, with regional, rather than local, deployment and better use of first responder schemes. The NAS control and dispatch system is currently operating within eight ambulance service regions with no interconnectivity of radio systems, thus restricting the service response flexibility. The service control centre reconfiguration project and associated ICT enabling projects aim to reduce the number of ambulance control centres from eight to one, operating over two sites - Tallaght and Ballyshannon - and transition communications from analogue to digital, including voice and data. The total value of this project, which commenced in late 2010, is €23 million.

The National Ambulance Service control centre reconfiguration project represents one of the most critical and complex pieces of the State's emergency infrastructure ever undertaken. The HSE's intention to reconfigure the existing ambulance control centres is consistent with international best practice and endorsed by the Health Information and Quality Authority, HIQA, as the most appropriate approach to improve the quality of services to patients and facilitate investment in technologically enabled service delivery.

This project is also a key element of Future Health: A Strategic Framework for Health Reform in Ireland 2012-2015.

Based on current known variables, the expected timescale for full commissioning, including the migration of all NAS ambulance control centres, is the end of 2014. Both the NAS and HIQA have a number of concerns about the control and dispatch structures at some existing control centres. In this context, the NAS intends to migrate a number of these centres to our existing facility in Townsend Street with a view to mitigating these concerns ahead of the completion of the national centre. The NAS is satisfied that Townsend Street is suitable and infrastructurally sound to facilitate the interim migration of Cork, Tralee and Navan control centres and it is providing additional staff, training, technology and equipment to facilitate this process. The migration of these control centres in the short-term will also improve the optimum and dynamic utilisation of all available resources in those areas, and peripheral areas, such as rapid response vehicles, intermediate care vehicles and emergency ambulances.

There can be no question of any compromise of patient safety and safety generally in the system in respect of any decision that is taken. That is paramount in respect of all considerations.

I thank the Minister of State for his reply; we are on the same page on this. Those who represent staff in the ambulance control centres, particularly SIPTU, are very concerned about patient safety. They have raised concerns about the move to this interim facility in recent days.

The Minister of State remarked that based on current known variables, the moves to the Tallaght and Ballyshannon centres will be complete by the end of 2014. That is welcome and those who represent staff have bought into that process. It complies with international best practice.

The Minister of State also mentioned that the National Ambulance Service and HIQA have some concerns about the control and dispatch structures at some of the existing control centres. It is my experience that the centres operate in a very effective fashion and comply with HIQA regulations and other aspects of the regulatory environment, as they are required to do. In this context, however, concerns have been raised by SIPTU that have been referenced with HIQA and the Health and Safety Authority related to the working environment at Townsend Street. As I understand it, the National Ambulance Service has refused to engage with the trade union concerned on an independent risk assessment of the site. These are experienced people working in the ambulance control sector and this is an experienced health sector trade union. If there are legitimate concerns, they should be pursued with the National Ambulance Service and should be taken seriously by HIQA and the HSA.

There is also a concern about the technology that is being used at the site. The move will not permit a single use system for call taking and dispatching, which can lead to confusion. We are all concerned about patient safety and efficiency in the ambulance service in terms of responding to emergencies and supporting staff to play a critical role in our health service. It is a concern for the Minister of State and the House and we must all ensure we do the right thing not just on behalf of the workers involved in the service but, specifically, the people who depend upon it.

I thank Deputy Nash and I agree with him; the input of staff and their representatives, including SIPTU, is vital. I expect and believe any concerns raised by SIPTU or any trade union should be taken seriously. I will not comment on the specific question of a specific risk assessment but I would expect there would be engagement with the trade unions on the proposals for Townsend Street. In fairness to the union in its press release, it acknowledged the National Ambulance Service is providing additional staff, training, technology and equipment to facilitate the process. I hear what the Deputy is saying about remaining concerns and I hope there would be positive engagement between management in the National Ambulance Service, SIPTU and other unions and the staff to ensure those issues can be addressed.

Medical Card Eligibility

During the Easter recess, Members of the Oireachtas received an e-mail from the HSE informing us that further restrictions in medical card eligibility were being introduced in April. In the communication the HSE told us it was amending the eligibility criteria relating to medical cards by removing home improvement loans and excluding the first €50 per week from travel to work expenses from the standard medical card means test assessment. The exclusion of travel to work costs relates to removing the weekly amount of €50 allowed to cover standing charges such as depreciation and running costs used when considering travel to work costs as an outgoing where public transport is not available or suitable and a car is required. The HSE says it will continue to consider the standard mileage and transport costs when assessing eligibility.

The impact of these changes will be significant, there is no getting away from that. The home improvement loan repayments have been a factor in the qualification of a number of people currently depending on the medical card. The added restriction with the removal of that first €50 will impact greatly, especially on rural Ireland, where there is no public transport service. In my constituency there is almost no public transport service and that dependency on travel to work costs being met is crucial.

These further restrictions follow the recent legislation that lowered the income threshold for medical card qualification for people over 70 years of age that we addressed in the week prior to the Easter recess. I asked repeatedly for details of where the other 20,000 who would be impacted by the HSE's service plan for 2013, which projected the loss of 40,000 medical cards in 2013, with 20,000 of those belonging to over 70s. Is this what was planned but could not be exposed here a week before Easter but was slipped out during the Easter recess? These further measures represent another cut to health services and I deplore the manner in which this was communicated. The cover note made no reference to the information that was contained therein, referring only to the eligibility criteria for over 70s, something we thought we had already addressed prior to Easter, with the unsatisfactory outcome I have already described.

It is regrettable the Minister for Health and the Minister of State with responsibility for primary care had not utilised the opportunity in the House prior to Easter or on our return to address this. I have endeavoured to raise this matter every week since the conclusion of the recess and have only now succeeded in having my issue selected.

I appeal to the Minister of State to secure a withdrawal of these measures mindful of the very serious consequences they will have for individuals and families currently dependent on the medical card.

I thank Deputy Ó Caoláin for raising this matter. The maintenance of health services is a priority in 2013 for the Government, despite the need for significant and challenging financial savings in the health area. Even with the extra resources made available to the Health Service Executive as part of budget 2013, just over €750 million in savings are needed during 2013. My script states €750 billion and bad and all as matters are, it is not a figure of that magnitude.

Budget 2013 set out the wide range of savings that were required and the general medical service, GMS, scheme was one of a number of areas identified. A number of steps are being taken to reduce the cost of the GMS, which costs about €2 billion per year. At the end of 2012, there were approximately 1,986,000 qualifying people under the GMS. Medical cards make up the majority of this number, amounting to about 93% of the total. As part of budget 2013, the Government has made provision for an additional 200,000 persons to be covered by the GMS. Nonetheless, it is important that we prioritise the use of scarce financial resources in the current budgetary position.

Among the budget 2013 savings measures announced was a reduction in the income limits for over 70s medical cards referred to by Deputy Ó Caoláin. It should be noted that the overwhelming majority of medical card holders aged over 70 are unaffected by that change. For the wealthiest 5% that are affected, those cardholders under the old income limits will continue to be provided with a free GP service. The Health (Alteration of Criteria for Eligibility) Act 2013 was enacted on 28 March last to give effect to the revised eligibility arrangements and the Deputy actively participated, as he always does, in the debates on the various Stages of that Bill.

Last December, at the time of the budget, it was also announced that the rules on a person's expenses that are taken into account in calculating their net income for medical card purposes would be tightened. The changes recently introduced by the HSE mean that payments on a home improvement loan and a €50 per week allowance for a car are excluded from the standard means test assessment. These changes took effect from April.

Where a decision is made by the HSE not to grant a medical card or a GP visit card, the applicant will be advised that they can request a review of the HSE decision if they believe their financial or other circumstances have not been correctly assessed. In such a circumstance the applicant may also be requested to provide any additional relevant information or details of any change in their circumstances since their original application.

To make the point clear, and Deputy Ó Caoláin clarified this correctly in the course of his contribution, the exclusion from travel to work costs relates to removing the weekly amount of €50 allowed to cover standing charges, such as depreciation or other running costs, used when considering travel to work costs as an outgoing where public transport is not available or suitable and a car is required. This means that the HSE will continue to consider the standard mileage costs or public transport costs when assessing eligibility. The Deputy will be aware that there are a broad range of allowable expenses under the means test assessment for medical cards that have not been affected by these changes.

I assure the Deputy that the changes were identified with a view to mitigating the impact on the assessment process while also yielding savings. In so doing, the new assessment arrangements continue fully to take account of a person's mortgage or rental expenses. In addition, other allowable expenses were protected in budget 2013. The need to reduce the income limits for medical cards was thereby avoided.

Again, I have to ask the Minister to accept that the situation regarding the transport expenses will significantly discriminate against people who live in the vast swathes of rural Ireland where there are no public transport facilities. Workers on comparable incomes carrying out similar tasks on a daily basis located in any of the major urban and city centres that have public transport will not be similarly affected. This is discriminatory against people who live throughout the country and, as I know of cases personally, in my constituency, particularly in Cavan and Monaghan.

Equally, in terms of home improvement loan repayments, while the Minister is continuing to make provision for the mortgage repayment element in the calculation, the home improvement loan, in terms of upgrading to particular enjoyable standards, is often essential. It can be for an expanding family or the particular needs of a disabled member of the household. There are a range of home improvement loans that are essential. They are not for decorative purposes or the sheer enjoyment of it. They are essential to the needs of the particular household and to cut that off with these consequences is unacceptable.

How can the Minister of State square the oft-claimed commitment of this Government, shown in its programme for Government document, to introduce universal access to primary care free at the point of delivery with the ongoing restrictions of medical card eligibility? These measures run contrary to the Minister's stated programme and his stated intent.

Deputy Ó Caoláin has raised that issue several times and I have answered it several times. I will now answer it again, particularly in the case of the over 70s debate we had and the legislation we introduced. It was pointed out to the House, and I repeat it today, and the Deputy must accept this because it is a fact, that anybody who had a medical card removed from them as a result of the changes made had a general practitioner, GP, visit card extended to them instead. It is simply not true to say, therefore, that this measure runs contrary to the policy.

There is no such guarantee in this situation.

The Deputy has many criticisms-----

That was for the over 70s.

Please, Deputy. There are not many people here. We do not have to interrupt each other. The Deputy has many criticisms that he can legitimately make and questions he can legitimately ask but it is not logical to say that it runs contrary to a policy when nobody has lost access to their GP-only card through any of these measures.

We are not talking about the over 70s now. I ask the Minister of State to please deal with the issue.

The Deputy asked how that runs contrary to the Government's policy to extend GP visit cards to the full population. It does not run contrary to it.

This is not about the over 70s.

The Deputy must accept that because it is factual. The Deputy asked me how it was consistent with the policy of free GP care. It is not inconsistent with that.

Home improvement loans. Transport costs to work.

This is difficult but the Deputy saw the level of cuts that had to be made. There is no doubt that it is extremely difficult but when we examine the various options, and we had to examine the options, we found every one of them difficult. Does the Deputy believe there is any adverse change or cut with which anybody on this side of the House feels comfortable? The answer is "No". We want to maintain as best we can the integrity of the system we have and the maximum amount of resource we have available to it to ensure that those resources are best used. That is what we are trying to do in the circumstances.

There is no automatic entitlement to a GP card when losing one's medical card under these measures.